VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Hilton Plaza, Inc.
311 Main Street
Newport news, VA 23601
(757) 596-6010

Current Inspector: Willie Barnes (757) 439-6815

Inspection Date: May 2, 2019

Complaint Related: Yes

Areas Reviewed:

22VAC40-73 ADMINISTRATION AND ADMINISTRATIVE SERVICES 22VAC40-73 PERSONNEL 22VAC40-73 STAFFING AND SUPERVISION 22VAC40-73 RESIDENT CARE AND RELATED SERVICES 63.2 Protection of adults and reporting.

Technical Assistance:

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Comments:

An unannounced complaint inspection was conducted on this date from 2:32p.m until 6:10p.m with co-worker W.B. in response to the assault of a resident that was not reported the licensing office within 24 hours. At the time of the inspection the administrative assistant was the person in charge. Interviews were conducted with several residents including the victim, staff present at the time of the incident, as well as other staff. Four staff records, two resident records, and some relevant facility records were reviewed. The inspectors were not provided any documentation of any previous aggressive behavior by the assailant who was incarcerated at the time of inspection. Residents and staff interviewed had nothing negative to say about the assailant . Some residents interviewed said the assailant was provoked . The person assaulted was not described favorably by the residents interviewed and there were documented behavior incidents. Make a notation of all self-audits with a date. Social data on all residents shall reflect a current legal representative, or agency contact( if applicable . There was a discussion about clarifying the job description of staff with multiple job tasks. Retraining on de-escalating behaviors is suggested for all staff. The complaint is valid regarding the facility failure to submit an incident report within 24 hours. It was also found that the facility failed to report the incident to APS, did not ensure all the residents were free from threats or degrading and demeaning acts, or posted a work schedule that reflected absences. Please complete the ?plan of correction? for each violation cited on the violation notice and return it to me within 10 calendar days from today on 5-30-19 You will need to specify how the violation will be or has been corrected. Just writing the word ?corrected? is not acceptable. Your plan of correction must include: 1. steps to correct the noncompliance 2. measures to prevent reoccurrences 3. Person(s) responsible for implementing and monitoring each step of the corrective measures and / or the preventative measures

Violations:

Standard #:	22VAC40-73-70-A
Complaint related:	Yes
Description:	Based on record review and interview the facility failed to report to the regional licensing office within 24 hours an incident that negatively affected a resident or that threatened the life, health, safety, or welfare of a resident. Evidence 1. According to a news release ,on April 28, 2019 resident #1 was taken into custody by police at a nearby pharmacy after fleeing from the facility following a physical assault of resident #2 in the backyard of the facility. 2. During interview with staff #2 and #3 and a review of the incident report that staff #1 stated had been faxed to the licensing office on 4-30-19@10:21a.m and 10:23a.m. and sent again on 4-30-19 @12 59p.m. and 1:01p.m. , the inspectors found the incident occurred around 3:00p.m. Staff #1 also provided the inspectors copies of the documents that she said had been faxed to the licensing office. The incident report indicated staff 31 and the consultant was made aware of the incident . 3. Also during interview staff #3 (the 3 to 11 staff on 4-28-19) told the inspectors shortly after arriving to work ,resident #2 was observed on the ambulance and was about to be taken to the hospital for medical treatment. 4. The report was not received in the licensing office within 24 hours of the incident .
Plan of Correction:	The Administrative Asst. faxed the incident report within 24 hours regarding the physical altercation between two (2) residents on Monday, April 29, 2019. However, the state did not receive it due to technical electrical problem of which the administrative asst. was not aware. On Tuesday, the administrative assistant refaxed the same information regarding the incident. A letter from Dominion Energy dated May 2, 2019 was received at the ALF. This letter was sent to the lead licensing Inspector on May 9 at 12:37pm stating that ALF had lost electrical power on 4/22/19 at 11:13am and lasted until 4/22/19 at 11:29am. The generator kicked in for the electricity of the ALF, but not to the fax machine. Staff said that they also had intermittent problems with the phone. Lead inspector said the state did not receive the fax on Monday, April 29, only on Tuesday, April 30. Again, Dominion verified the outage that caused the fax machine to malfunction on April 29, and again staff member was not aware that the fax had not gone through. The computer/camera man came on May 3, 2019 at 7:13pm and fixed the computerized part of the cameras. A picture of the computer man was sent to lead licensing Inspector on May 3. STEPS TO CORRECT THE NONCOMPLIANCE: Unable to correct. Power problems occurred. The administrative assistant will inform by telephone any electrical problems beyond our control. The administrative assistant or supervisor will fax incident reports to state licensing inspectors within 24 hours. MEASURES TO PREVENT REOCCURRENCES: State inspector asked for all FYI?s and incident reports to be emailed to her, but she had difficulty opening some of the emailed documentation. Therefore, on May 7, the state inspector said that the administrative assistant could fax information to her. State inspector also said that she was willing to accept phone calls. The administrative assistant will call the licensing inspector to confirm receipt of the faxed FYI?s regarding incidents. She will also document in her facility?s appointment book when the FYI?s and the ?follow-ups? were sent and documented to the state inspector. Same documentation will be filed in residents? charts. PERSON RESPONSIBLE FOR IMPLEMENTING AND MONITORING EACH STEP OF THE PREVENTATIVE MEASURES: The administrative assistant and/or supervisor of the shift will report to the administrator that the FYI?s and ?follow-ups? have been completed.
Standard #:	22VAC40-73-150-F
Complaint related:	No
Description:	Based on observation, interview, and record review the facility failed to ensure , the administrator served on a full-time basis as the on-site agent and was responsible for the day-to-day administration and management of the facility. Evidence 1. Upon arrival to the facility at 2:32p.m , the inspectors advised staff #1, the administrative assistant, of the purpose of the inspection and asked if the administrator was present. Staff #1 stated no and in the presence of the inspectors proceeded to called a person identified as the facility's consultant to advised her of the inspectors presence . The consultant arrived about 20 minutes after receiving the call. During the inspection the administrator was not on site. 2. A review of the copy of the written work schedule provided during the inspection for a two week period beginning April 21 2019 and ending May 4,2019 indicated the administrator was scheduled to work 27 hours each week. The schedule listed the administrator's hours as followed for the week beginning April 21, 2019 and ending April 27,2019 : 11 to 5 on Monday ; 8 to 2 on Tuesday and 11 to 4 on Wednesday, Thursday , and Friday . The administrator was not scheduled to work Saturday or Sunday(May 27and 28-2019). The schedule listed the administrator's work hours as followed for the week beginning April 28 and ending May 4 : 11 to 5 on Monday ; 8 to 2 on Tuesday and 11 to 4 on Wednesday, Thursday , and Friday . The administrator was not scheduled to work Saturday May 4,2019. 3. The incident report listed staff #1 and the consultant as the persons contacted about the incident .
Plan of Correction:	Administrative Assistant never changed dates or times from previous years, when there were two licensed administrators on-site. Administrative assistant will update the real times. The Administrator is present and on-site; his days start at 6am, 7am, 8am?he orders food, picks up the food, orders and picks up supplies, assists with repairs, meets with repair people?plumbers, electricians, elevator people, etc. There is an administrative assistant who is here from 8:30am to 5pm, five days a week. She provides coverage. The office is small and he utilizes a consultant and an administrative assistant to deal with complying with federal, state, and city regulations, companies and problems. Everyone works together as a team. However, the administrator comes and has been here when inspectors were here. Two licensing inspectors and the two different Regional Licensing Inspectors have been present along with the Administrator in the past. The Administrator had left approximately 2:00pm on May 2, 2019. This is a stand-alone facility, however, he has to deal with all of the repairs, shopping and/or maintenance of the building outside of the facility. STEPS TO CORRECT THE NONCOMPLIANCE: The administrative assistant changed administrator?s work hours to reflect the true time he is on-site, and when he is out. MEASURES TO PREVENT REOCCURRENCES: The Administrative assistant will monitor the administrator?s time daily. PERSON RESPONSIBLE FOR IMPLEMENTING AND MONITORING EACH STEP OF THE PREVENTATIVE MEASURES: The administrator will inform the administrative assistant of any changes in the documented time on the posted schedule.
Standard #:	22VAC40-73-290-A
Complaint related:	No
Description:	Based on observation record review and interview the facility failed to maintain a written work schedule that included any absences, substitutions, or other changes . Evidence 1. On 5-2-19, upon arrival at the facility at 2:32p.m. the inspectors asked staff #1, if the administrator was present . The inspectors were told no. Upon requesting , reviewing, and being provided a copy of the written posted schedule for the period April 21,2019 and ending May 4 2019 ,the inspectors found the administrator was scheduled to work from 11 to 4 on the day of the inspection (5-2-19). 2. The copy of the written schedule provided to the inspectors during the inspection did not include any documentation of any absences or changes to the administrator 's schedule for 5-2-19 . 3. The staff acknowledged the schedule had not been changed .
Plan of Correction:	STEPS TO CORRECT THE NONCOMPLIANCE: The administrative assistant changed administrator?s work hours to reflect the true time he is on-site, and when he is out. MEASURES TO PREVENT REOCCURRENCES: The Administrative assistant will monitor the administrator?s time daily. She will document all future absences, changes, etc. The schedule will be checked by the administrative assistant weekly to ensure that the schedule has been appropriately updated. PERSON RESPONSIBLE FOR IMPLEMENTING AND MONITORING EACH STEP OF THE PREVENTATIVE MEASURES: The administrator will inform the administrative assistant of any changes in the documented time on the posted schedule. Both will check the schedule weekly.
Standard #:	22VAC40-73-550-C
Complaint related:	Yes
Description:	Based on record review and interview the facility failed to ensure all residents of the assisted living facility were provided the rights and responsibilities in ? 63.2-1808 of the Code of Virginia and this chapter and were free from emotional abuse and free from threats or other degrading or demeaning acts . Evidence 1. During interview the inspectors were told of threats and intimidation by resident #2 ,which alledgedly had been reported to the administrator , to staff #1 and or to the consultant. 2. The four residents interviewed described resident #2 as" pushy, threatening, a bully, "argues and cusses and will get in your face"."will raise his fist at you" and "has been in several fights" 3. During interview with the inspectors resident #2 was reserved when asked about how he got the injuries to his face and arm . He stated he was "fine" and I don't want to take about it " and abruptly ended the interview . 4. The inspectors were provided copies of what the facility consultant described as "spacial incidents" involving resident #2's behaviors. The following is what was documented in the copies provided to the inspectors : a. On 6-11-18 the resident met with the administrator , the consultant and staff #1 and signed the following statement :" I will not touch or hit anyone else. I will come to the office and report any problems." b. A person wrote at 10:47 on 11-7-18 (no a.m. or p.m noted in the report) that resident #2 got agitated and started to exchange words with resident #1. He threw a cup of ice on his face and throw a chair at me(the writer) " c. Documentation of a psych appointment on 2-6-19 indicated , the resident admitted he had been drinking , the administrator informed the resident "he got agitated when he drank" and recommended the resident "not drink anymore". During the 2-6-19 appointment the doctor provided a list of local AA meetings. The resident made a "vow not to drink anymore " The administrator signed the dated summary of the 2-6-19 appointment . 5. Resident # 2 was assaulted on 4-28-19 by resident #1 and received emergency medical care .
Plan of Correction:	Resident #2 forgave Resident #1, and they shook hands when resident #1 returned to the facility on May 10. (Resident #1) and (Resident #2), May 10, 2019 at 9:22pm Staff asked if they could take a picture and both residents said, ?Yes.? STEPS TO CORRECT THE NONCOMPLIANCE: Residents shook hands voluntarily. Staff advised Resident #2 to stop flirting, since Resident #2 had not escalated in April because he was the "victim." Resident #2 only escalated three times from June, 2018 to April 28, almost one year in May, 2019, as consultant said "spatial" in an assisted living facility with residents who are mentally ill. Resident #2's flirting was the antecedent to Resident #1?s escalation. Resident #2's POA is only financial. This is Resident #1's first time escalating physically, therefore, staff members have advised him not to be so jealous, and not to become physical with anyone because of his girlfriend. MEASURES TO PREVENT REOCCURRENCES: Staff advised Resident #2 to stop flirting with other residents? friends. Staff advised both residents to come to the office if they had problems. Both will continue to seek psychiatric help, and facility staff members will observe them closely if they are in the same area, and when Resident #1 is with his girlfriend. PERSON RESPONSIBLE FOR IMPLEMENTING AND MONITORING EACH STEP OF THE PREVENTATIVE MEASURES: All staff, supervisors of each shift.
Standard #:	63.2-1606-A
Complaint related:	No
Description:	Based on interview the facility failed to ensure a reports was made to the local department or the adult protective services hotline by a persons acting in their professional capacity: who is licensed, certified, or registered by health regulatory boards Evidence 1. During interview with staff #1 on 5-2-19, the inspectors were told the facility did not make a report to adult protective services regarding the assault on resident #1 that required emergency medical care. 2. Staff #1 stated resident #1, attended a nearby church service and a member of the church saw the bruises on resident #1's face and made a report to APS.
Plan of Correction:	STEPS TO CORRECT THE NONCOMPLIANCE: Cannot be corrected with this incident. However, in the future, the administrative assistant and/or the administrator will notify Adult Protective Services (APS) as soon as possible when an incident of abuse, neglect and/or exploitation occurs with residents age 60 and over. MEASURES TO PREVENT REOCCURRENCES: The supervisors of the shifts will inform the administrative assistant as soon as possible of probable APS incident reports. The supervisors of the shifts will assist in documenting the probable incident. The administrative assistant will make a decision to report and document same. PERSON RESPONSIBLE FOR IMPLEMENTING AND MONITORING EACH STEP OF THE PREVENTATIVE MEASURES: The supervisors of each shift and/or administrative assistant.